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  2. CQM-5538

CMS68 (PY 2022) EC Consultation on Inpatient Stay

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      ​Thank you for your question regarding CMS68v11: Documentation of Current Medications in the Medical Record. CMS68 is an episode-based measure that is attributed to all encounters for eligible clinicians during the measurement period. In the example you have provided, the measure is satisfied for the inpatient hospital stay. However, the cardiology consult is considered a separate encounter (i.e. a separate CPT code being billed for a different eligible clinician), and documentation of medications is required by this measure for all eligible encounters (see relevant logic below). Each eligible clinician would have to review/document meds at each encounter to satisfy measure requirements.​

              "Qualifying Encounter during Measurement Period" QualifyingEncounter

                 with ["Patient Characteristic Birthdate": "Birth date"] BirthDate

                  such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start

                  of "Measurement Period" ) >= 18
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      ​Thank you for your question regarding CMS68v11: Documentation of Current Medications in the Medical Record. CMS68 is an episode-based measure that is attributed to all encounters for eligible clinicians during the measurement period. In the example you have provided, the measure is satisfied for the inpatient hospital stay. However, the cardiology consult is considered a separate encounter (i.e. a separate CPT code being billed for a different eligible clinician), and documentation of medications is required by this measure for all eligible encounters (see relevant logic below). Each eligible clinician would have to review/document meds at each encounter to satisfy measure requirements.​         "Qualifying Encounter during Measurement Period" QualifyingEncounter            with ["Patient Characteristic Birthdate": "Birth date"] BirthDate             such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start             of "Measurement Period" ) >= 18
    • CMS0068v11
    • Clarification for eligible clinician reporting and EHR documentation

      We are seeking clarification on eligible clinician consulting services performed in connection with an inpatient stay and how these consults should be reflected on the eligible clinician’s MIPS quality reporting. This question is specifically regarding CMS68 but could be extended to other episode-based EC measures as well.

      If over the course of an inpatient/acute stay an eligible clinician performs a consultation, would that consult be considered a separate visit for the purposes of CMS68 and thus should appear in the Initial Patient Population? 

      For example, the patient has a five day inpatient stay. Medication reconciliation is performed at the beginning of the patient’s admission by the hospitalist. At some point, a cardiologist is called for a consultation on the patient. CPT 99223 is billed for the cardiology consult. Would this be considered a separate visit and added to the denominator for this measure? Is the Cardiologist expected to perform medication reconciliation as part of their consultation with the patient to be counted in the numerator?

      Thank you for your time

            edave Mathematica EC eCQM Team
            jgraber Jon Graber
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